Saturday, December 3, 2016


This is regarding internship aka 1st year of residency in my program

General rules
Most programs make each module lasting 4 weeks, and they generally start on a Monday in internship. There are a TOTAL of 13 modules for the academic year, with a month for vacation

The first month was more of getting used to the EMR system in the hospital while figuring out how to get from home to hospital and back! Another part of starting new in a place is figuring out transportation. Should you be in New York, the public system is well connected. However, in Cleveland, the same is not true! You will need a vehicle if you intend to survive internship, at least that is what I think! Let me give you the following example- If I take the bus daily, I will take an hour to reach work, but if I have a car I will reach the SAME place in 20 mins, which translates to 40 more minutes of sleep! Who says no to that! 

Lastly, it takes every resident, in my opinion, a good number of days to learn how to function in a new unit. But, I feel as long as you have good seniors, you will thrive, no matter where you are! 

EMR (Electronic Medical record)
Things that I would recommend future applicants to look for is definitely the EMR (electronic medical record) system which a hospital uses. For example, my program uses EPIC, which is PRETTY powerful. We do NOT have written documents and thanks to a tie up with different hospitals within the EPIC ecosystem we are able to access patient records in other hospitals as well. 

As an intern trying to learn the ins and outs of Epic, took me a GOOD amount of time ~a month, and that too I only knew the basics. Till date I keep finding out new things about epic, both from my current interns as well as the attendings I work with, to say the least.

Things the EMR is used for - writing daily progress notes, results for labs that were sent and at times to mail another physician via the patient workspace about patient information. When I started my residency, my PD and chief, realizing that we as IMG's have a lot to learn placed us in electives, which helped us learn how to function in epic without getting too overwhelmed. For my good fortune, I had a co-resident, with who I powered through learning EPIC.

Wise wisdom from a senior of mine- 'Internship is not about learning, it is more about surviving! You are in a new place, with new colleagues, learning new etiquettes and to top it you have a NEW EMR to figure out, the best you can do in this year is to survive! You will start learning in your junior and senior year; so make mistakes and don't be shy to ask questions, as you are here to learn!' And now that I am in the 2nd year of residency I cannot but express how true those words are! Internship is more about getting to work and getting your responsibilities done in time i.e. time management.

Most programs have the same set of modules, but just different names. Our program has a good mix of general floors, subspeciality floors, outpatient experience, ED, electives, NICU and vacation in internship. 

I started off with electives, which for me was perfect, I used to have a good amount of teaching, and given we had to get certified in BLS, NRP and PALS, my attending used to let us off for the needed amount of time! I loved the attendings who I worked with and I imbibed some of their signature moves, so to say, because they were so good! 

For the next rotation I went into NICU, this for many of the pediatric residents, seems to be the bane of their existence. For this, I went in with advice from a senior, who said 'You either hate the NICU or you love it, there is nothing in between!'  I had amazing seniors in the NICU, who helped me out, not only by helping me write progress notes, but by also doing some of them on my first day when they realized I was freaking out and sweating buckets!! Here knowing dot phrases (things we use in epic to auto populate results) plays a major role!

And then finally I went into the floors! Again I had amazing seniors! I still won't forget the first day I did my pre-rounds, I was a mess. My seniors, to whom I am ever thankful for, took me aside and pointed out what was wrong and ways that I could improve, and after that floors were a piece of cake. Towards the end of the rotation I even was told that compared to what I did on day 1, I was a much better resident at the end! The work times for floors as an intern is hard! You have to reach early in the morning, so as to finish pre-rounding, which includes knowing the overnight events, labs that were sent if any and a focused physical examination. Here I feel in addition to talking to the overnight resident, the nurses play a major role, as they know minute by minute play of what happened with each patient. Learning to admit and discharge patients along with discharge summaries, is a MAJOR role done by interns. Towards the end of internship you realize what labs to focus on and how to present cases better, things like lab trends make more sense that just reporting numbers! In floors, you depend on your co-residents to help you out with work like admission and discharges, seniors for tips and tricks with EMR and nurses and finally the attending on how to interact with patients!

In the States there is something called as a resident team clinic (continuity clinic)- This is a place where you get to see every week on a particular day, a set of kids for well child visits. You become a child's pediatrician, something that I am sure most of you want to do! You get to see a child grow up in front of you which is a wonderful experience.! In this team clinic, you are generally with a preceptor who helps in molding your general pediatrician skills. There are so many things you can learn from you preceptors if you only let them teach you! The urgent care clinic is considered the outpatient experience. You get to see a wide variety of illness from colds to rashes to asthmatics to what not! You learn to figure out which is a sick vs, not sick kid!

Lastly, we also have a rotation in the newborn nursery which I must say was really amazing for multiple reasons! One since you have cute babies there and 2 because my attending was amazing and 3 because my colleagues were hilarious! 

As your residency progresses, you will learn that your co-residents play a MAJOR part in how you like your program. Even seniors, since if you don't know anything they are the people who can guide you to the correct answer. In my program at least, my batchmates are really amazing! Everyone steps up if the work is too much for one to handle! Lastly, we throw random functions for no good reason! 

Fellows, though people say are not good, I feel if you use them in the right way they are the best people to have. For example, you are interested in a particular sub-speciality, fellows help in telling you what things you should look for in a program and they are also more approachable compared to attendings given they are younger as well as they know what a resident is going through! 

Now at the end of my internship, the only thing I look back and think, if I had to do it over again I would not change anything! The entire year was one roller coaster ride, but it was worth it!

If there is any grammatical error, please excuse it! Just wrote this in an hour for people who are going to come over for residency!

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